Enhancing blood Donation at Schools and Beyond: An implementation Science study Project Summary Over the past decade, Malawi has made substantial progress in improving critical health measures including reducing infant, under-5 years mortality, maternal mortality rate, and HIV associated deaths. Despite this progress, preventable deaths from malaria-associated anemia and obstetric hemorrhage still occur due to blood shortage in the country. Over the last 15 years, the Malawi Blood Transfusion Services (MBTS) has dramatically increased its capacity for blood collection and distribution, but the goal of 100% collection by MBTS has not been achieved and there remains a 27% deficit of the nation?s need. Current MBTS program data suggest secondary student donations programs yield the highest uptake of blood donations but many of these student donors are not retained long term, particularly after graduation. As regular donors provide the lowest risk of transmitted transfusion infections, identifying effective strategies for increasing regular donors is critical in ensuring sustainable supply of safe blood. The application?s emphasis is on identifying sustainable and efficient donor recruitment and retention strategies that would increase safe blood donations in Malawi, taking advantage of the apparent enthusiasm of youth to donate blood and their relatively low risk of transmitted transfusion infections. Specifically, three aims will be implemented: Phase 1 (UG3), Aim 1: Conduct spatial, epidemiological and Hemovigilance analysis of existing MBTS and Ministry of Health (MOH) data from current blood collections systems to identify optimal functioning districts for replication, data quality improvement and potential inclusion for implementation science trial; Aim 2: Conduct evaluation of facilitators and barriers to blood collection and repeat donations according to high and low performing districts/programs/schools in order to inform and refine implementation science strategy; and Phase 2 (UH3), Aim 3: Determine the effectiveness of an enhanced Malawian-tailored school-based donation club program to promote first time donation and engage donor retention post-secondary school. Informed by a Consolidated Framework for Implementation Research, we expect this proposed trial will yield culturally sensitive, age appropriate incentive programs, donor messaging and communication strategies to maximize enthusiasm for donation. The consortium brings together a multi-disciplinary research team with expertise in blood transfusion medicine, epidemiology, behavioral science, implementation science and familiarity with the Malawian culture and context to achieve the objectives. Implementation science capacity building for young Malawian investigators is embedded within the grant?s activities to ensure continued research in blood transfusion medicine long term.